The mechanism is real. That is not the same as the treatment working.
Radiation at doses far below those used to treat cancer — typically fractions of a gray rather than tens of grays — modulates inflammation rather than killing tissue. The DEGRO consensus guideline on radiotherapy of non-malignant disorders reviews the experimental basis: in vitro and in vivo models confirm an anti-inflammatory effect of low-dose X-irradiation, acting through immunological pathways and the behaviour of endothelial cells, leukocytes and macrophages (Reichl et al., Strahlenther Onkol 2015; DOI 10.1007/s00066-015-0865-8).
The same guideline is explicit that radiogenic risk must be weighed whenever radiation is used for a benign condition. That is the whole difficulty. In cancer, a small late risk is set against a lethal disease. In a boil, a flare of psoriasis, or a pneumonia that most patients survive, the arithmetic is completely different — and it is the arithmetic, not the mechanism, that decides whether a treatment should exist.
The COVID-19 lesson, which we are not going to skip past
When COVID-19 pneumonia overwhelmed critical care in 2020, whole-lung LDRT was proposed on exactly the reasoning above, and trials began worldwide. The results are the most instructive thing that has happened in this field in decades, and they did not go the way the enthusiasm predicted.
Single-arm and matched-control studies looked encouraging. A prospective phase I–II trial of 1 Gy whole-lung LDRT in 41 patients reported improved radiological extension scores and oxygenation indices (Sanmamed et al., LOWRAD-Cov19, Radiother Oncol 2022; DOI 10.1016/j.radonc.2022.03.015). A matched controlled study of 11 treated patients reported better chest X-ray severity scores (Mousavi Darzikolaee et al., J Med Radiat Sci 2021; DOI 10.1002/jmrs.542).
The randomised, double-blind trial did not. Patients ventilated for COVID-19 pneumonia were randomised to 1 Gy whole-lung LDRT or sham irradiation. There was no difference in ventilator-free days at day 15, and 28-day survival was identical in both arms at 63.6%. The authors' conclusion is one sentence: whole-lung LDRT failed to improve clinical outcomes (Papachristofilou et al., Int J Radiat Oncol Biol Phys 2021; DOI 10.1016/j.ijrobp.2021.02.054).
A joint National Cancer Institute / NCRP / NIAID workshop had already declined to either endorse or refute the approach, and published a framework for how such studies should be conducted (Prasanna et al., Radiat Res 2020; DOI 10.1667/RADE-20-00211.1).
We put this second on the page, before any list of promising indications, deliberately. Every condition below has the same shape as COVID-19 pneumonia did in early 2020: a real mechanism, a desperate clinical need, and encouraging uncontrolled reports. Uncontrolled data on an inflammatory illness that fluctuates on its own will look like a treatment effect whether or not one exists. The Institute treats that as the governing lesson of the field.
Candidate indications and where the evidence actually stands
| Indication | Rationale | Evidence state | What a study would need |
|---|---|---|---|
| Refractory plaque psoriasis | T-cell–driven inflammatory skin disease; superficial, accessible to orthovoltage; historical dermatologic X-ray use is extensive. | Historical use and case series; no modern randomised comparison against current systemic and biologic therapy. | Randomised comparison in disease genuinely refractory to biologics, with PASI endpoints and long-term cutaneous malignancy surveillance. |
| Furuncles & carbuncles | Localised pyogenic inflammation; one of the classic pre-antibiotic radiation indications. | Historical (pre-antibiotic era) reports only. Antibiotics and drainage are effective, cheap and carry no radiogenic risk. | Honestly: a persuasive case for why radiation should be preferred to drainage and antibiotics at all. Absent that, this remains of historical interest. |
| Hidradenitis suppurativa | Chronic, disabling, often refractory to every available therapy — the risk–benefit arithmetic is far more favourable than in a simple boil. | Case series; no randomised data. | Prospective trial in Hurley stage II–III disease failing biologics, with quality-of-life primary endpoints. |
| Acute pancreatitis | Severe systemic inflammatory response with high mortality and no specific therapy. | Preclinical and anecdotal. No controlled human data. | Preclinical replication first, then a phase I safety study — not a jump to efficacy claims. |
| COVID-19 pneumonia | Cytokine-driven lung injury. | Randomised evidence is negative in ventilated patients (see above). Positive single-arm data did not replicate. | The Institute does not consider this an open question in critically ill patients on current evidence. |
| Non-COVID infectious pneumonia | Same inflammatory rationale; the historical literature predates antibiotics. | Historical only. The randomised COVID result is a direct caution against assuming benefit. | A clear account of which patients modern care fails, before any irradiation is contemplated. |
| Osteoarthritis & enthesopathies | The best-established benign indication in routine European practice. | The most mature evidence base of anything on this list; covered by the DEGRO guideline. | Not a future indication so much as an under-used present one in US practice. |
The rules we hold ourselves to before opening any of these
- The comparator is best available care, not nothing. A treatment that beats no treatment in a self-limiting condition has proved very little.
- Randomised and blinded where a sham is ethical. The COVID experience shows precisely what unblinded, uncontrolled data does to an inflammatory endpoint.
- Benign disease means benign-disease follow-up. A patient irradiated for psoriasis at 40 may have fifty years in which a second malignancy can appear. Trials that stop at twelve months cannot see the harm they are meant to exclude.
- Younger patients raise the bar, they do not lower it. Radiogenic risk falls with age at exposure being higher, not lower — the youngest patients carry the most lifetime risk.
- Negative results get published. Through IJRM-SSS, whether or not they favour a technique CureRays uses.
- Registered before enrolled. Pre-registration with the primary endpoint fixed in advance.
Current status
Everything on this page is a research agenda. None of these indications is offered as treatment by CureRays Radiation Medicine, and nothing here should be read as a recommendation for care. Where a trial opens, it will appear on the Institute’s research pages with its registration identifier, and enrolment will run through the clinic.
If you are a clinician or investigator who thinks one of these is worth doing properly — or thinks one of them should be struck from the list — the Institute would rather hear it than not.